Dentistry for Children
Pediatric Dentistry
2551 North Green Valley Parkway, Suite 400A, Henderson, NV 89014
702-458-6684
  • Patient Information
    • Introduction
    • First Visit
    • Scheduling
    • Financial Policy
    • Insurance
    • Privacy Policy
    • Sedation
    • Pain Control
    • FAQ
    • Laser
    • New Techniques
  • Pediatric Dentistry
    • Introduction
    • Tooth Brushing
    • Thumb Sucking
    • Tooth Eruption
    • Baby Bottle Decay
    • Cavity Prevention
    • Gum Disease
    • Adolescence & Oral Care
    • Trauma & Other Post Op Care
  • Othodontics
    • Introduction
    • Removable Appliances
    • Types of Bites
    • Classification of the Teeth
  • Meet Us
    • Meet Dr. Sina
    • Meet the Staff
  • Games
    • Color Picker
    • Coloring Charts
    • Connect to PBHS Games
  • Online Forms
    • Patient Registration
    • Referral Form
    • Office Forms
  • Contact Us
    • Henderson Office Map/Directions
    • Las Vegas Office Map/directions

Online Forms

  • Patient Registration
  • Referral Form
  • Office Forms

Patient Registration Form

Please download and fill-out our Patient Registration Form. After you have completed the form, please make sure to bring it on your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

  • Download Our Patient Registration Form

Technical Note:

You need Adobe Acrobat Reader to view our form. Please download the free Acrobat Reader from Adobe's web site if it is not already installed on your system.

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Dentistry for Children

Address: 2551 North Green Valley Parkway, Suite: 400A, Henderson, NV 89014 .::. Phone: 702-458-6684 • Fax: 702-450-9498

Address: 700 E. Silverado Ranch, Suite: 110, Las Vegas, NV 89014 .::. Phone: 702-431-6600 • Fax: 702-450-9498

 

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